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To the Editor: We believe that the ALLHAT authors¹ inappropriately emphasized their results for heart failure, although it was only 1 component of a secondary composite outcome. This focus on heart failure previously led to early termination of the doxazosin arm from the trial.²

The authors concluded that chlorthalidone was the preferred treatment of hypertension. To do so, they inverted the order of their nonstatistically significant results, as this drug actually had worst point estimates for primary event rate (11.5% chlorthalidone vs 11.3% amlodipine or 11.4% lisinopril) and for all-cause mortality (17.1% vs 16.5% or 17.0%, respectively). Surely those end points are worthy of more attention than heart failure, which is often difficult to diagnose. Similarly, the authors present 3 Kaplan-Meier plots featuring heart failure and elaborate on secondary outcome components; however, they omit primary outcome data for nonfatal myocardial infarction.

The INSIGHT trial,³ in which we participated, was a . . . [Full Text of this Article]